*For medical professionals for reference
The doctor shouted "忒 忒"!
Writing 丨 Thailand
Presence
A 89 -year -old woman, because of " Lost Cingles of Repeated Seizure for 6 days" to emergency treatment.
6 days ago, patients began to lose short -term consciousness, and they were held about 3 times a day. Patients had hallucinations and illusion before each attack.The second arm trembling was lost after 5 ~ 10 s.
During the unconscious period, the patients eyes kept open and stared upwards.After recovery, the patient is very directed and can recall the hallucination experience independently.Both upright and lying positions can be occurred, and no bite or incontinence occurs during the attack.
Patients have appeared (TIA) due to the right cervical stenosis;Obstructive pulmonary disease (COPD), medium -sized hypertrophy (LVEF 50%), moderate aortic valve stenosis (average pressure gradient 28 mmHg), and medium to severe valve and valve insufficiency, no history of mental illness.
When the patient is admitted to the hospital, the blood pressure is 150/104 mmHg, the heart rate is 58 times/minute, the upper edge of the right upper edge of the sternum can be heard, and the reducing reduction period is mixedMissy.
The nervous system examination is unique.
Auxiliary examination: Laboratory examination+chest tablets are normal.
ECG (ECG) indicates sinus arrhythmia and left ventricular hypertrophy with myocardial strain.
The skull CT prompts that the left -side base section area is old and static cerebral infarction stove.
During the occurrence of patients, the EEG, ECG, and Synchronous Records were monitored during the seizures.After a few seconds, the patient had hallucinations, screams, and tremors after , and finally lost consciousness.
At the same time, the EEG prompts after the equal potential, and there is a diffuse high wave amplitude slow wave activity (see video and picture).
Figure 1: The 21 -led EEG, ECG (red line) monitored by the patients consciousness before and after the seizures monitored the room conduction block in a few seconds.After the symptoms, after the ECG monitored a few seconds of fighting, the patients consciousness was lost, and the EEG prompts during the reactive period of the high wave amplitude slow wave activity+flat wave+high wave amplitude slow wave activity ("slow-flat-slow" is a typical EEG manifestation of syncopeTo.
Phantom+tremor+short -term consciousness lost. In the past, cerebral infarction+structural heart disease in the base section area, no history of mental illness, what caused consciousness to lose consciousness lossWoolen cloth?
Sihogging is not uncommon in cardiology and neurology, but the investigation of potential causes may hide mystery.The main causes that cause short -term consciousness include seizures, heartogenic syncope, reflective syncope, and posture syncope.
Differential diagnosis
● Epilepsy seizures
The characteristics of epileptic seizures include a threatening of epilepsy or incense (such as lingering, unilateral limb tremor) before the seizure.Disdible and prone to bite, consciousness after attack.However, because the symptoms of epilepsy and syncope are very similar, it is very difficult to identify the two by symptoms.
For example, muscle activity such as tremor and sound may also be caused by cerebral ischemia, and epilepsy can also be followed by arrhythmia, which increases difficulty to the diagnosis of this patient.
Is this patient a seizure or syncope?
If it is syncope, the cause of the syncope of patients needs to be based on a careful medical history collection, including the occurrence of patient syncope, the nature and duration of the symptoms and duration of the symptoms, and the duration.At the time of the seizure, the symptoms of the bedside, the symptoms after the attack, the detailed history and the history of medication, whether there is a family history related to syncope and the sudden death.
● Petality syncope
reflex syncAnd contextual syncope.Patients with vascular vascular syncope are usually healthy young people, accompanied by obvious primary symptoms caused by obvious vagus tension, such as nausea, pale, and sweating; typical inducement mainly includes environmental factors or emotional factors.
A few elderly patients can also occur when combined with cardiovascular disease and take antihypertensive or induce hypotension. But syncope for patients with structural heart disease when they are tired, first consider heart -derived factors rather than reflective syncope.
Situation syncope is usually induced by factors such as urination, swallowing, cough and sneezing.
● 体 Tips
It may be very similar to the symptoms of syncope. It is very difficult to identify the two alone;
Phantom+tremor+short -term consciousness loss is most likely to be reminiscent of seizures, but hallucinations may also mean halo.The timing of hallucinations is very important for identification and diagnosis: The hallucination experience of syncope occurs during the period of consciousness, and the prelude hallucinations indicate that the seizures may be seizures ;
